Passive movement involves moving a joint without active muscle contraction and can be classified into three types: relaxed passive movement, forced passive movement, and continuous passive movement (CPM). Relaxed passive movement maintains range of motion through slow, pain-free movements while CPM specifically refers to a device that continuously moves a joint post-surgery to prevent stiffness and adhesions. Both relaxed passive movement and CPM aim to preserve range of motion and circulation. Contraindications include recent fractures or injuries while benefits of CPM include reducing post-operative complications and improving recovery.

1. PASSIVE MOVEMENT

2. PASSIVE MOVEMENT
These movements are produced
by an external force during muscular
inactivity or when range of motion is
reduced for any cause.

3. CLASSIFICATION OF PASSIVE MOVEMENT
 1- Relaxed Passive Movements, including
accessory movements.
 2- Forced Passive movement.
 3- continuous Passive movement.

4. 1- RELAXED PASSIVE MOVEMENT

5. 1- RELAXED PASSIVE MOVEMENT
 Definition:
These are movements performed accurately,
rhythmical and smoothly by the physiotherapist through
available range of motion( according to anatomy of joints)
. The movements are performed in the same range and
direction as active movements. The joint is moved
through the free range and within the limits of pain.

6. PRINCIPLES OF RELAXED PASSIVE
movement
1-Relaxation:
The selection of a suitable starting position
ensures comfort and support, for both patient and
physiotherapist through the movement.
2-Fixation:
Good fixation for the proximal and distal joint by
the physiotherapist to ensure that the movement is
localized to the movable joint.
3-Support:
Full and comfortable support is given to the part
to be moved, so that the patient has confidence and
will remain relaxed.

7. PRINCIPLES OF GIVING RELAXED PASSIVE
MOVEMENTS
4-Traction:
The fixation of the bone proximal to the joint providing
an opposing force to a sustained pull on the distal bone.
Traction is thought to facilitate the movement by reducing
inter- articular friction.
5-Range of movement :
The range of movement is done in painless range to
avoid spasm in the surrounding muscles.
6-Speed and Duration:
As it is essential that relaxation is maintained
throughout the movement, the speed must be slow and
rhythmical, with suitable repititions of the movement.

8. EFFECTS AND USES OF RELAXED
PASSIVE MOVEMENTS
 1- Maintain range of motion and prevent formation of
adhesions.
 2- Maintain the physiological properties of the muscle
(extensibility, elasticity, etc.) and prevent shortening and
contracture.
 3- Help in preserving and maintain the memory of the
movement pattern by stimulating the kinaesthetic
receptors.

9.  4- The mechanical pressure resulted from the
stretching of the thin walled vessels which passing
across the moved joint will assist the venous and
lymphatic return( improving circulation).
 5- Can be used in training of relaxation as the
rhythmic continuous passive movements can have
a soothing effect and induce further relaxation and
sleep.
 6-Improving sense of position and sense of
movement.

10. Indications of relaxed passive movement
1-In cases of paralysis, patient who is confined in bed for a long time or
complete rest on bed.
2-when there is an inflammatory reaction and active movement is
painful.
3-when the patient in coma.
4-In relaxation as a factor helping to reduce spasm in group of muscles.

11. Contra-indications of relaxed passive movement
1-unhealed fracture, recent fracture, at the site of
fracture.
2-At site of effusion or swelling.
3-Immediately following surgical procedure to tendon,
ligaments, joint capsule.
4-Immediately after recent tear to ligament, tendon.
5-when a bony block limits joint motion e.g. myosities
ossificans.
6-Recent injuries
7-sever muscle weakness.
8-Acute inflammation or infection as arthritis,
osteomylities.

12. II- Forced passive movement
 Definition
An exercise performed on a subject by a partner
who exerts an external force not only to produce a
passive movement, but also to increase the range
of movement of a joint. The partner presses the
joint into its end-position (i.e. end of range), while
the subject's muscles that normally carry out the
movements are completely relaxed. There is a
danger of overextension beyond the range of
movement and damage to the joint if the exercise is
not carried out carefully.

13. EFFECTS AND USES OF FORCED
PASSIVE MOVEMENTS
As in relaxed passive movement, but specially
increasing the limited range of motion.

14. 111- Continuous passive motion (CPM)
A continuous passive motion device
maintains movement of a joint after limb
sparing surgery. This device is usually
called a CPM. Continuous movement limits
stiffness and pain. It is very important to
keep joints moving following surgery so that
motion will not become limited. The CPM
will move the involved leg through its full
range of motion. It is only used in bed, but
can be used while relaxing, eating, or
sleeping.

15. Benefits of CPM
1-decreasing the complication of immobilization.
2-decreasing the post operative complication and
pain.
3-improving the recovery rate and ROM.
4-improving the circulation through pumping action.
5-prevent adhesions and contracture.
6-prevent joint effusion and wound oedema.

16. Procedure of CPM
It is important that you understand the use of CPM. The therapist
may adjust the device to fit you before surgery. You will begin to use
the CPM right after surgery. Your therapist will give you instructions
and monitor how you use the device. The CPM is set to allow 45
degrees of motion right after surgery. Generally, motion will be
increased about 15 degrees a day. You will need to use the CPM for
about 6 weeks after surgery.